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(Circulation. 1995;91:2497-2498.)
© 1995 American Heart Association, Inc.

Articles

Cardiac Sarcoidosis

⁶⁷Ga Imaging and Histology

Makihiko Saeki, MD; Hitoshi Kitazawa, MD; Makoto Kodama, MD; Tohru Izumi, MD; Akira Shibata, MD; Shigeo Kido, MD; Fumiaki Masani, MD

From the First Department of Internal Medicine, Niigata University School of Medicine, Niigata; Niigata Prefectural Shibata Hospital (S.K.), Shibata; and Kuwana Hospital (F.M.), Niigata, Japan.

Correspondence to Makihiko Saeki, MD, First Department of Internal Medicine, Niigata University School of Medicine, Asahimachi-dori 1-754, Niigata 951, Japan.

	Introduction

 
A 23-year-old man was admitted to Niigata Prefectural Shibata Hospital in September 1992 because of sustained ventricular tachycardia and cardiogenic shock. After cardioversion of the ventricular tachycardia, his ECG showed sinus rhythm, left axis deviation, complete right bundle branch block, and left anterior fascicular block. The cardiac silhouette was slightly enlarged on chest x-ray films, and hilar lymphoadenopathy was present. Moderate leukocytosis (11 000/mL), liver injury, and moderate renal insufficiency were found, with moderate increase of serum angiotensin-converting enzyme (ACE) (42.2 IU/L) and lysosomes (15.5 mg/L). Asymmetric left ventricular hypertrophy was initially observed by echocardiogram, then hypokinesia and thinning of the left ventricular wall progressed gradually (percent fractional shortening from 30% to 14%).

Scintigraphic imaging with ⁶⁷Ga revealed significant abnormal uptake in the heart, eyes, and bilateral hilar lymph nodes (Fig 1). Coronary arteriography revealed a normal coronary artery. Histological examination of the endomyocardial biopsy showed noncaseating granuloma with epithelioid cells (Fig 2). Thus, he was diagnosed as having sarcoidosis with preferential cardiac involvement. After he was given prednisolone, left ventricular function, ACE, and lysosome count slowly improved.

View larger version (65K): [in this window] [in a new window]   Figure 1. 67Ga image. Before the prednisolone therapy, intense 67Ga accumulation in the heart, eyes, and bilateral hilar lymph nodes is seen.

View larger version (0K): [in this window] [in a new window]   Figure 2. Light microscopic figure of endomyocardial biopsy. Semithin sections of epoxy resin–embedded myocardium were triply stained by Kurotaki's method. Before the therapy, obvious granuloma intermingling among the cardiomyocytes was observed. Magnification x400.

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